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J Am Acad Orthop Surg, Vol 13, No 2, March/April 2005, 101-109.
© 2005 the American Academy of Orthopaedic Surgeons
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Salvage of Failed Treatment of Hip Fractures

George J. Haidukewych, MD and Daniel J. Berry, MD

Dr. Haidukewych is Orthopaedic Traumatologist and Adult Reconstructive Surgeon, Florida Orthopedic Institute, Tampa, FL. Dr. Berry is Professor of Orthopaedics, Mayo Clinic College of Medicine, and Consultant, Orthopaedic Surgery, Mayo Clinic, Rochester, MN.

Reprint requests: Dr. Haidukewych, Florida Orthopedic Institute, 13020 Telecom Parkway, Temple Terrace, FL 33637.

Typically, patients with failed internal fixation of a hip fracture have marked pain and disability. These patients may present treatment challenges. Salvage is tailored to the anatomic site of the nonunion, the quality of the remaining bone and articular surface, and patient factors such as age and activity level. In younger patients with either a femoral neck or intertrochanteric fracture nonunion with a satisfactory hip joint, treatment typically involves revision internal fixation with or without osteotomy or bone grafting. In older patients with poor remaining proximal bone stock or a badly damaged hip joint, conversion to hip arthroplasty can restore function effectively and reduce pain. For femoral head salvage procedures, choosing a fixation device and accurate preoperative planning are the major challenges in decision making. For conversion to arthroplasty, the major challenges are assessing the need for acetabular resurfacing, selecting the femoral implant, and managing the greater trochanter. Technical challenges include broken hardware, deformity, and femoral bone defects. Attention to technical details can minimize potential complications.






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Copyright © 2005 by the American Academy of Orthopaedic Surgeons.